Healthcare Provider Details

I. General information

NPI: 1255446795
Provider Name (Legal Business Name): DONNA M ROSS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 W WOOLBRIGHT RD BUILDING 2
BOYNTON BEACH FL
33435-5908
US

IV. Provider business mailing address

115 W WOOLBRIGHT RD BUILDING 2
BOYNTON BEACH FL
33435-5908
US

V. Phone/Fax

Practice location:
  • Phone: 561-375-9660
  • Fax:
Mailing address:
  • Phone: 561-375-9660
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW5108
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: